Provider Demographics
NPI:1326301177
Name:DELAGI, HEATHER BLYTHE (NP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:BLYTHE
Last Name:DELAGI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 FAIRCHILD DR STE 112
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-2254
Mailing Address - Country:US
Mailing Address - Phone:650-396-8080
Mailing Address - Fax:
Practice Address - Street 1:465 FAIRCHILD DR STE 112
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-2254
Practice Address - Country:US
Practice Address - Phone:650-396-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20613363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily